Healthcare Provider Details

I. General information

NPI: 1134083843
Provider Name (Legal Business Name): OLIVIA FULTON OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2280 IVY RD STE G271
CHARLOTTESVILLE VA
22903-4977
US

IV. Provider business mailing address

PO BOX 749112
ATLANTA GA
30374-9112
US

V. Phone/Fax

Practice location:
  • Phone: 434-243-0311
  • Fax: 434-243-0320
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119011203
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: